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The aims of the present study were to evaluate test-retest intra-observer repeatability of ultrasound measurement of the morphology and function of the pelvic floor muscles (PFM).Seventeen subjects were tested twice. Two-, three-and four-dimensional ultrasound recorded cough, huff, muscle morphology and PFM contraction, respectively. Analyses were conducted Perineal ultrasound is a reliable method for measuring most of the tested parameters regarding morphology and function of the pelvic floor muscles. ACKNOWLEDGEMENTS OF FUNDUNG

Objective To evaluate the interobserver repeatability of measurement of the pubovisceral muscle and levator hiatus, and the position of related organs, during rest, muscle contraction and Valsalva maneuver using three-and fourdimensional (3D and 4D)

Objective To investigate the risk factors for pelvic organ prolapse (POP), including physical activity, clinically measured joint mobility and pelvic floor muscle (PFM) function.Design One-to-one age-and parity-matched case-control study.Setting Akershus university hospital and one outpatient physiotherapy clinic in Norway.Population Forty-nine women with POP (POP quantification, stage ‡II) and 49 controls (stages 0 and I) were recruited from community gynaecologists and advertisements in newspapers.Methods Validated questionnaires, interview and clinical examination, including Beighton's scoring system (joint hypermobility) and vaginal pressure transducer measurements (PFM function), were used. Univariate and multivariate conditional logistic regression analyses for one-to-one matched case-control studies were used, and odds ratios with 95% CIs are reported.Main outcome measures Pelvic floor muscle function (strength, endurance and resting pressure), socioeconomic status, body mass index, heavy occupational work, physical activity, family history, obstetric factors and markers of connective tissue weakness (striae, varicose veins, bruising, diastasis recti abdominis, joint hypermobility).Results No significant differences were found between groups with regard to postmenopausal status, current smoking, current low-intensity exercise, type of birth (caesarean, forceps, vacuum), birth weight, presence of striae, diastasis recti abdominis and joint hypermobility. Body mass index (OR 5.0; 95% CI 1.1-23.0), socioeconomic status (OR 10.5; 95% CI 2.2-50.1), heavy occupational work (OR 9.6; 95% CI 1.3-70.3), anal sphincter lacerations (OR 4.5; 95% CI 1.0-20.0), PFM strength (OR 7.5; 95% CI 1.5-36.4) and endurance (OR 11.5; 95% CI 2.0-66.9) were independently related to POP.Conclusions Body mass index, socioeconomic status, heavy occupational work, anal sphincter lacerations and PFM function were independently associated with POP, whereas joint mobility and physical activity were not.Keywords Anal sphincter lacerations, body mass index, casecontrol, joint hypermobility, occupational work, pelvic floor muscle, pelvic organ prolapse, socioeconomic status, varicose veins.Please cite this paper as: Braekken I, Majida M, Ellström Engh M, Holme I, Bø K. Pelvic floor function is independently associated with pelvic organ prolapse.

A correct pelvic floor muscle (PFM) contraction was described by Kegel (1) as an inward lift and squeeze around urethra, vagina and rectum. In addition, DeLancey (2;3) suggested that a PFM contraction may press the urethra against the pubic symphysis (PS), further mechanically increasing urethral pressure. Traditionally PFM function and strength have been assessed by visual observation, digital palpation and use of different manometers and dynamometers (4). None of these measurement methods are capable of simultaneously measuring both the lifting and squeezing function in a responsive, reliable and valid way.Neither can any of these methods measure muscle morphology. Today imaging techniques such as ultrasound and magnetic resonance imaging have the potential of yielding more detailed information about muscle morphology and action during PFM contraction. 3D and 4D ultrasound allow multi planar imaging, assessment in an upright body position and utilizing a rapid sampling time. In addition, there are few contraindications and it may, due to relatively low cost, therefore be adopted into future clinical practice (5). To date, mainly the lift of the bladder neck (BN) has been investigated (6;7). To our knowledge only one study has quantified pubovisceral muscle length reduction (8), and no studies have quantified narrowing of levator hiatus (LH) area and transverse distance during contraction. Position of cervix uteri, rectal ampulla or back sling of the puborectal muscle has not been assessed, neither has the magnitude nor the direction of the displacement of these organs during PFM contraction.The aims of the present study were to evaluate test-retest measurements of functional aspects of PFM contraction using 4D real time ultrasound by:1. Measuring pubovisceral muscle length, LH area, antero-posterior and transverse dimensions at rest and maximal contraction (axial plane) 2. Measuring lift (displacement) of the BN, cervix uteri, rectal ampulla and back sling of the puborectal muscle (sagittal plane) MATERIALS AND METHODSThe study was designed as a test-retest intra-tester study. Two test series were performed with an interval of 7 to 35 days. The participants received a random identification number. The assessor was blinded to the results of test 1 during test 2. SubjectsSeventeen female volunteers were recruited for the study. Inclusion criterion was ability to contract the PFMs. Correct contraction was defined as inward lift of the PFM as assessed by ultrasound. Exclusion criterion was inability to understand instructions given in the Norwegian language. No volunteers had to be excluded. The study was approved by the Regional Medical Ethics Committee, and the Data Inspectorate of Norway. All subjects gave written informed consent to participate. ApparatusA GE Voluson 730 expert ultrasound system (GE Healthcare, Oslo, Norway) with 4-8 MHz curved array 3D/4D ultrasound transducer (RAB 4-8 l/obstetric) was used. The field of view angle was set to its maximum of 70 º in the sagittal plane and volume acquisition an...